Under The Knife

Explaining The Life of a Medhead

the archives are now free.

All Baseball Prospectus Premium and Fantasy articles more than a year old are now free as a thank you to the entire Internet for making our work possible.

Not a subscriber? Get exclusive content like this delivered hot to your inbox every weekday. Click here for more information on Baseball Prospectus subscriptions or use the buttons to the right to subscribe and get instant access to the best baseball content on the web.

One of the hardest things I have to do is explaining what I do. I tried to get the word "medhead" to stick, but it never did. I'm a writer focused on telling the story of sports through the lens of sports medicine. Since few others try to do this, it's a hard concept to grasp for some, despite injuries being one of the greatest factors for winning and losing, second only to talent. I'm not a stathead. Never have been, never will be. When I first came to work at Baseball Prospectus, I was told by one of the original writers that I wouldn't fit in and he was right. While I've attempted to use some statistical tools to help bring the medhead side up to speed, it's always been with assistance. In the media, I often get asked to explain what PECOTA or VORP is and I can articulate it well enough, but the fact is, I'm the guy who can't balance his checkbook and only passed Algebra II because I played baseball. When writing about injuries, I don't have box scores to work from. I don't have the whole of Baseball-Reference or Retrosheet to check against. The outright arrogance of some statheads and the inability to market any of the tools they've developed have held things back. I'm sure the same could be said of me and the medhead side of things. I'm not shy, I say plenty of stupid things, and that's led to some focusing on the persona rather than the work. If there's one thing I could change in the last nine years, it's that.

It was really no surprise this week when Mauer had a cortisone injection. As I've been telling you here, the inflammation in Mauer's knee is controllable and fixable, but for right now, the team needs to move its focus from the long grind of the season to making sure that he is available for the playoffs. With a more compressed schedule, the Twins medical staff can't use off days to manage this. For all those saying that Ron Gardenhire is the best manager in the game, here's a chance to see how he can manage a clearly delineated issue: how to maximize the value of Mauer. Once the season is over, Mauer and the Twins can take a look at whether he'll need the knees cleaned out, but with each minor leg problem, they're adding on to the overarching problem of how long Mauer can stay behind the plate without losing the value of his bat. Mike Piazza, previously the best-hitting catcher, didn't have the long history with leg problems. The same is true for Jorge Posada, a late convert to the position. (Maybe the Giants feel better about Buster Posey suddenly.) How the team manages Mauer throughout a long, expensive contract will be key to whether they're in this position year after year. We could see Mauer back this weekend, especially since he's pushing for it, but the Twins could hold him out until the beginning of next week.

It took a long time to find two small floating fractures near Hamilton's back. If this reminds you of the issues surrounding Jacoby Ellsbury, it should. Even with modern medical imaging, some things are just tough to see, but easy to feel. The finding means that Hamilton's situation is known, but is it controllable? The answer seems to be yes, with the goal being to get Hamilton back on the field late next week. The Rangers still aren't sure what, if anything, will bother Hamilton and getting a chance to run him through drills and see him in game action is going to be key. They have enough flexibility on the roster that they'll be able to handle the outcome, even if Hamilton is limited to DH. One thing that keeps getting discussed is whether Hamilton uses painkillers. While Hamilton does have an addiction history, he was not addicted to painkillers or narcotics. The Rangers have never offered guidance on whether Hamilton does use painkillers (or would, if necessary), but we know that Hamilton has taken cortisone injections. Those are normally done with a painkiller mixed in, usually xylocaine. Sources also tell me that Hamilton has used phonophoresis, a treatment that also involves a painkiller, at times in the past.

We might not have a Triple Crown winner, but Gonzalez has inserted himself in the discussion for the mythical "best player in baseball" title. The Triple Crown went by the wayside after a thumb injury sapped some of his grip strength and therefore some power, but Gonzalez adjusted quickly and started slapping hits. I'd love to see one of those spray charts or HitFXgraphs, but I don't have those kinds of resources to work with. The fact that Gonzalez was able to make the adjustment and willing to do so speaks pretty highly of his talents. There shouldn't be a long-term concern here, though we've seen hand injuries really escalate this year. One theory is that the stronger maple bats used this year—and by stronger, I mean passing the maple standards put forth this year—that there's a bit more vibration transferred to the hands. There's no way of telling if that's the case or whether this is just a coincidence, but Gonzalez can't get better until he gives his hands some time off. The Rockies hope that doesn't come until November.

Depending on the source, Cueto was topping out at somewhere between 88-91 mph on Wednesday night. No matter the source, he was awful in one of his shortest outings. Cueto looked absolutely gassed from the first pitch to the last and made many wonder if he had anything left for the playoffs. At this stage, he'll need to show something in his next outing, but that next outing needs to come with extra rest. The Reds have used a deep rotation of adequate starters all but wrap up the NL Central but as they head into the postseason, adequate just doesn't cut it. The Reds insist this is nothing more than a bad outing and that Cueto has passed every manual test. If Cueto doesn't bounce back from this, the Reds playoff rotation looks like Bronson Arroyo, Edinson Volquez, Travis Wood, and Homer Bailey. Having Aroldis Chapman lurking in the bullpen isn't going to make up for a rotation of 4s and 5s.

Like Cueto, Latos had one of his worst starts of the season during his last outing. With his workload and a recent illness, it's understandable and in any other situation, the Padres would have shut him down. As the team fights for its playoff life, it has to extend Latos a bit more and hope it gets a lot better results while not hurting his future. He's already 31/2 wins better than the projection for his season, so "squeezing the orange" for a bit more is tempting fate. Latos is being watched closely by the coaching staff and the medical staff for any sign of mechanical or physical breakdown. If his next start out is as bad as his last, the Padres' decision isn't going to be any easier. Then again, that's why Jed Hoyer is making the big bucks, to make precisely this kind of long-term vs.short-term decision.

Torres was able to take batting practice on Thursday, his first major step in returning from an appendectomy. The San Jose Mercury News' Andrew Baggarly got to see Torres work and said that he started out tentatively, but was hitting some bombs by the end. Power isn't really Torres' game, but it's batting practice. Power there means Torres was able to swing freely, a very good sign. The Giants are hoping that Torres is able to come back quickly, thought it doesn't appear that he's going to be ready for the Rockies series this weekend. Given the importance, the Giants could elect to make him available and with the expanded roster, there's really no cost to doing so. Let's split the difference on the ERD and tip our cap to the laproscope that made this possible.

If Wezen Ball can track home run trots, I hope someone out there can collect hit by pitch data. I wonder what the hardest HBP was this year?Did it connect solidly or glance off? Where did it hit him? Why doesn't Gameday's representation of pitches show this already? Braun got stone-cold smoked on the elbow, not for the first time this season. With rules put in place after body armor got a bit outrageous, Braun and most other players don't have the Craig Biggio-style protection available to them. Does this keep them from diving in and contribute to the reduction in homers? Quite possibly, if you listen to some hitters and hitting coaches. As sabermetrics moves from the easily quantifiable to trying to quantify and analyze what has long been scouting information, perhaps we'll see a new blended approach somewhere. For now, the Brewers will be very cautious with returning Braun to the field in this lost season for the team and disappointing campaign for their star.

The Cardinals haven't been eliminated from the NL Central race but seeing how they're shutting down Molina, they've been eliminated in their minds. Molina isn't headed for surgery, but there's a good bit of inflammation in his knees. Yes, knees—plural. If Molina is merely worn down, he'll be fine. If the meniscuses (no, it's not meniscii) are just worn as you'd expect in a catcher, rest and treatment and a little less squatting will help him. Molina is such a key part of the pitching program and defense in St Louis that one could make an argument that he's as irreplaceable as Albert Pujols. The Cardinals are smart to be smart with him and keep any minor knee problem from becoming a major one.

Pence blogged that he was hoping to ... wait, what? Yeah, if one thing has changed, it isn't the access I have with the BBWAA card, it's that athletes are blogging and tweeting enough that sometimes, the beat writers have to get worried. Pence blogged that he hoped the mild hip strain that he had would clear up enough for him to pinch hit on Thursday. I guess Brad Mills reads his blog and thought that he was healthy enough to play, because he wrote his name into the lineup. Pence didn't appear to have any trouble during the game, going 2-for-4. Assuming that he doesn't stiffen up or have soreness today, we can expect that Pence will play normally going forward.

Quick Cuts:

What's more surprising, that Jose Bautista (32 home runs more than his PECOTA projection) is hitting or that Pablo Sandoval (three full wins below his PECOTA-projected WARP) isn't? ... Tyler Colvin was released from the hospital. It looks like there will be no further problems from his encounter with a maple bat shard, but nothing yet has changed to make sure no one else has a similar injury ... Jimmy Rollins hasn't made much progress with his strained hamstring. The team isn't going to put a timeline on any decision for his inclusion on the post-season roster. He did participate in a simulated game on Thursday, but his running was limited ... Joey Votto is expected back tonight after missing a couple games with a sinus infection ... Jim Edmonds didn't tear his Achilles on a home run trot, but it is very irritated. That could keep him off the post-season roster ... Andrew Bailey will have "cleanup surgery" on his elbow, which amounts to a checkup and removal of bone chips ... A source tells me that it would take a "miracle" to get Justin Morneau back this season. He also said the Twins are much more worried about his future than this postseason ... Kirk Gibson acknowledged what I'd been warning about for weeks—the Diamondbacks could shut Justin Upton down for the season ... Sounds like the Braves are shutting down Mike Minor for the regular season, though he could still pitch in the postseason ...Fred Lewis will have his foot fixed and be ready for spring training. Always fun to see Dr. Angus McBryde's name and yes, it always makes me think of this... Can't be scared to fail. See you next week.

re Hamilton: are the more addictive analgesics such as opiates ever used on baseball players on a daily-dose, prescription type basis? is it possible or safe to be a functional baseball player when on codeine or tramadol or etc?

while I'll miss his injury info, I certainly won't miss his passive aggressive drama queen act or his overinflated self importance. you write a column, will. it's cool info, we all like it very much. I don't need the rest of your act.

I agree 100% with beerd. Part of being a professional is keeping your employment issues out of your body of work. If you stick to reporting on the injuries and not your personal battles, you'll have more luck moving "on to the next one".
BTW, xylocaine is a local anesthetic, not a "painkiller", as the latter implies potential narcotic use. Xylocaine has absolutely zero abuse potential. Why include any info re use of such in notes on Josh Hamilton - it has no value except to try to raise readers' eyebrows.